Foster Geoff, Orne-Gliemann Joanna, Font Hélène, Kangwende Abigail, Magezi Vhumani, Sengai Tonderai, Rusakaniko Simba, Shumba Bridget, Zambezi Pemberai, Maphosa Talent
*Ministry of Health and Child Care, Mutare, Zimbabwe; †Family AIDS Caring Trust, Mutare, Zimbabwe; ‡INSERM U1219-Centre Inserm Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; §Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France; ‖Clinical Research Centre, Africa University, Mutare, Zimbabwe; ¶North West University, School of Basic Sciences, South Africa; #University of Zimbabwe, College of Health Sciences Harare, Zimbabwe; and **Organization for Public Health Interventions and Development, Harare, Zimbabwe.
J Acquir Immune Defic Syndr. 2017 Jun 1;75 Suppl 2:S207-S215. doi: 10.1097/QAI.0000000000001360.
Prevention of mother-to-child transmission elimination goals are hampered by low rates of retention in care. The Eliminating Paediatric AIDS in Zimbabwe project assessed whether mother support groups (MSGs) improve rates of retention in care of HIV-exposed infants and their HIV-positive mothers, and maternal and infant outcomes.
The study involved 27 rural clinics in eastern Zimbabwe. MSGs were established in 14 randomly selected clinics and met every 2 weeks coordinated by volunteer HIV-positive mothers. MSG coordinators provided health education and reminded mothers of MSG meetings by cell phone. Infant retention in care was defined as "12 months postpartum point attendance" at health care visits of HIV-exposed infants at 12 months of age. We also measured regularity of attendance and other program indicators of HIV-positive mothers and their HIV-exposed infants.
Among 507 HIV-positive pregnant women assessed as eligible, 348 were enrolled and analyzed (69%) with mothers who had disclosed their HIV status being overrepresented. In the intervention arm, 69% of infants were retained in care at 12 months versus 61% in the control arm, with no statistically significant difference. Retention and other program outcomes were systematically higher in the intervention versus control arm, suggesting trends toward positive health outcomes with exposure to MSGs.
We were unable to show that facility-based MSGs improved retention in care at 12 months among HIV-exposed infants. Selective enrollment of mothers more likely to be retained-in-care may have contributed to lack of effect. Methods to increase the impact of MSGs on retention including targeting of high-risk mothers are discussed.
母婴传播消除目标因护理留存率低而受阻。津巴布韦消除儿童艾滋病项目评估了母亲支持小组（MSG）是否能提高暴露于艾滋病毒的婴儿及其艾滋病毒阳性母亲的护理留存率以及母婴结局。
该研究涉及津巴布韦东部的27家农村诊所。在14家随机选择的诊所设立了MSG，由艾滋病毒阳性的志愿母亲每两周协调一次会议。MSG协调员提供健康教育，并通过手机提醒母亲参加MSG会议。婴儿护理留存定义为艾滋病毒暴露婴儿12个月大时在医疗保健就诊时“产后12个月按时就诊”。我们还测量了艾滋病毒阳性母亲及其艾滋病毒暴露婴儿的就诊规律性和其他项目指标。
在评估为符合条件的507名艾滋病毒阳性孕妇中，348名被纳入并进行分析（69%），其中披露艾滋病毒感染状况的母亲比例过高。在干预组中，69%的婴儿在12个月时得到护理留存，而对照组为61%，差异无统计学意义。干预组的留存率和其他项目结局在系统上高于对照组，表明接触MSG有积极健康结局的趋势。
我们未能表明基于机构的MSG能提高艾滋病毒暴露婴儿12个月时的护理留存率。更有可能留存于护理的母亲的选择性纳入可能导致了效果不佳。讨论了提高MSG对留存率影响的方法，包括针对高危母亲。
